We assessed breakpoint changes of 13,101 Enterobacterales and Pseudomonas aeruginosa isolates from the past decade. All β-lactams and fluoroquinolones demonstrated decreased susceptibilities following breakpoint changes. Enterobacter cloacae experienced the largest average decrease in susceptibility amongst the Enterobacterales at 5.3% and P. aeruginosa experienced an average decrease in susceptibility of 9.3%.

Background: The epidemiology of Clostridioides difficile infection (CDI) is complex, and the COVID-19 pandemic has had extreme impacts on known risk factors such as comorbidity burden and antibiotic prescribing. However, whether these changes have affected the incidence of hospital-associated CDI (HA-CDI) remains unknown. We compared incidence and trends of HA-CDI before and after the pandemic onset, and we assessed the impact of changes in key CDI-related risk factors. Methods: We conducted an interrupted time-series study (March 2018–March 2021) of adult inpatients hospitalized 4 or more days with no known CDI on admission at a 576-bed academic medical center. Our primary outcome was monthly HA-CDI per 10,000 patient days. We performed segmented linear regression to compare the preinterruption trend in HA-CDI rate to the postinterruption slope and level change. We established a series of 30-day intervals before and after the interruption timepoint of March 23, 2020, which corresponds with the Oregon stay-at-home executive order. The data included 24 preinterruption time points and 12 postinterruption time points. We also assessed changes in slope and trend for known HA-CDI risk factors. Results: We included 34,592 inpatient encounters in our prepandemic period and 10,932 encounters in our postinterruption period. The mean prepandemic HA-CDI rate was 4.07 cases per 10,000 patient days. After the pandemic onset, the rate was 3.6 per 10,000 patient days. However, the observed differences in rate (both in terms of slope and level) were not statistically significant (P = .90 for level; P = .60 for slope change). We observed a significant decrease in admissions per 30 days (1,441 vs 911; level-change P < .0001) and a slight increase in the mean number of Elixhauser comorbidities (1.96 vs 2.07; level-change P = .05). We also observed significant increases in both frequency and intensity of antibiotic use, with an increase average days of therapy per encounter (5.8 vs 7.2; level-change P = .01; slope-change P < .0001) and in antibiotic spectrum index (ASI) points per antibiotic day (4.4 vs 4.9; P < .0001). We observed a consistent downward trend for case days of CDI colonization pressure per hospital day (preinterruption slope P < .0001), which remained consistent after the pandemic onset (P = 0.5 for postinterruption slope change) (Fig. 1). Conclusions: Despite significant increases in high-intensity antibiotic use and comorbidity burden, we did not observe significant differences in HA-CDI after the pandemic onset. This may be due to the significant decrease in colonization pressure in the postpandemic period. Further research is required to fully understand the impact of the pandemic-related changes on

Disclosures: None

Objectives: Patients undergoing hemodialysis using a catheter are at significant risk of developing central venous catheter–related bloodstream infections (CRBSIs), especially with methicillin-resistant Staphylococcus aureus (MRSA), resulting in increased morbidity, mortality, and cost. In our 1,000-bed regional hospital, the average CRBSI (any bacteria) rate in patients dialyzing via dialysis catheters was 1.44 per 1,000 catheter days, and the average CRBSI (MRSA) rate was 0.56 per 1,000 catheter days. A quality improvement project was initiated to reduce the overall dialysis CRBSI and CRBSI-MRSA by 50%. Methods: Following the formation of a multidisciplinary team, the catheter-insertion protocols and catheter-care protocols were standardized throughout the hospital. We adopted a well-established scientific quality improvement method, plan–do–study–act (PDSA) cycle model for all interventions that were implemented. The patients and general ward nursing staff were provided education and training in dialysis catheter care. Results: The project was initiated in January 2016, and the initial improvement was seen from July 2017 onward. Analysis of the data since 2016 showed a steady improvement in the overall CRBSI rates, as well as CRBSI-MRSA rates. The average CRBSI rate improved to 0.76 per 1,000 catheter days, and the average CRBSI-MRSA rates improved to 0.15 per 100 catheter days in the calendar year 2021. Conclusions: Because the causes of these infections are multifactorial, emphasis should be placed on improving care processes from the patient preparation phase prior to catheter insertion to regular catheter care in the inpatient wards and dialysis units. We attribute the success of our project to involving all stakeholders and obtaining constant feedback from the staff. We successfully applied PDSA cycles to make relevant incremental changes.

Objectives: Sharp injuries are frequent occurrences in healthcare settings. According to the World Health Organization, >2 million occupational exposures to sharp injuries occur among 35 million healthcare workers (HCWs) annually. We report the 5-year incidence and trends of sharp injuries in an acute-care hospital. We compared the rates of injury, the distribution of injuries, and the type of exposure of HCWs during the prepandemic and pandemic eras. Methods: We conducted a retrospective analysis of a 5-year surveillance on self-reported sharp injuries in Changi General Hospital, a 1,000-bed acute-care hospital. The occupational groups, the type of sharps, and the incident activity involved were reviewed. The bloodborne pathogen statuses of the identified source patients were studied. Results: In total, 441 sharp injuries were reported from 2017 to 2021. Among the occupational groups, doctors reported the highest number of sharp injuries (N = 272, 61.7%), followed by nurses (N = 129, 29.3%) and other allied health professionals (N = 29, 6.4%). An increasing proportion of doctors reported sharp injuries from 2017 to 2019 (prepandemic era) and the proportion declined from 2020 to 2021 (pandemic era); 52 doctors (58.4%) reported sharp injuries in 2017, 61 (61.1%) in 2018, 72 (67.9%) in 2019, 47 (61%) in 2020, and 40 (57.1%) in 2021. Most sharp injuries were caused by solid sharps (212 of 441, 48.1%) and hollow-bore needles (205 of 441, 46.5%). Source patients were identified in 407 sharp injuries. From the known sources, 51 were seropositive: 20 for hepatitis B (HBV), 27 for hepatitis C (HCV), and 4 for human immunodeficiency virus (HIV). No seroconversion occurred. Overall, 198 sharp injuries (44.9%) were sustained during surgical procedures, 83 (18.8%) occurred during blood taking, and 44 (9.9%) occurred during injection administration. Also, 37.5% of sharp injuries among doctors occurred during surgical procedures, and 69.6% of sharp injuries in OT occurred among junior surgical doctors. Conclusions: The overall incidence of sharp injuries has decreased during the pandemic. Fewer elective surgical procedures were performed during the pandemic period. OT suturing training workshops and awareness programs on strategies for preventing sharps injuries in the operating theatre, targeted at surgical residents during the past 2 years, could have contributed to the decrease in the incidence of sharp injuries in our hospital. Sharp injuries pose a significant exposure to blood and body fluids and should be subject to continued epidemiological surveillance.

Analyzing data from a national deidentified electronic health record-based data set using a matched case–control study design, we found that antibiotic use and severity of illness were independent risk factors for healthcare-associated candidemia in adult patients hospitalized with SARS-CoV-2 infection. Interleukin-6 inhibitor and corticosteroid use were not independent risk factors.

We report 9 patients with invasive Bartonella infections, including 5 with endocarditis, who were diagnosed with microbial cell-free DNA next-generation sequencing and Bartonella serology studies. Diagnosis with plasma mcfDNA NGS enabled a faster clinical and laboratory diagnosis in 8 patients. Prompt diagnosis impacted antibiotic management in all 9 patients.

Objectives: Surgical-site infections (SSIs) cause significant increases in mortality, morbidity, and prolonged hospitalization after cesarean deliveries. We assessed the effectiveness of the implementation of an SSI bundle in reducing postoperative infections in cesarean deliveries in a tertiary-care teaching hospital in Malaysia. Method: We conducted a quality-improvement study on all women who underwent labor and scheduled cesarean sections at the University Malaya Medical Center (UMMC) between May and December 2020. The preintervention period was May–June 2020 and the postintervention period was September–December 2020. Patients were followed for 90 days after their operation. Before the intervention, SSI rates and compliance with prevention practices were documented. A multidisciplinary team was formed, and education regarding the elements of the SSI prevention bundle was conducted before they were implemented. The care bundle focused on monitoring compliance with preoperative bathing, contact time for skin preparation, hair management, and antibiotics prophylaxis given within 60 minutes prior to incision, as well as patient education. Result: With the implementation of the SSI bundle, we observed a significant reduction in the SSI rate by 50%, from 7 per 100 procedures to 2 per 100 procedures. Compared with the preintervention period, overall compliance with bundle elements improved greatly for preoperative bathing (0 vs 95.7%) and contact time for skin preparation (0 vs 98.8%). In the postintervention period, the method of hair removal was documented, compared to no documentation during the preintervention period. The administration of prophylactic antibiotics within 60 minutes prior incision decreased from 99% to 92.3%. Conclusion: Implementation of an SSI prevention bundle successfully reduced the rate of SSI after cesarean section. The SSI prevention bundle together with improvements by multidisciplinary teams and a good patient-safety culture helped reduce SSI rates. Patient education on pre- and postoperative infection prevention also played an important role in reducing this infection rate.